Something New

October 8, 2014 By scottdm 1 Comment

Actually, it’s more accurate to say, “Everything is new!” The International Center for Clinical Excellence is coming up on its fifth birthday! Since its launch in 2010, the ICCE has become the largest, online community of behavioral health practitioners and researchers in the world. To celebrate, we are launching an entirely new web platform. All the features you’ve come to expect remain—the discussions with colleagues, the document library, the commercial free atmosphere. At the same time, everything has been streamlined, made faster, easier, and more intuitive. Log in today! Join a forum. Start a conversation. Share a presentation or paper with others. As you can see my own website has been completely redone. The “Top Performance” blog is now front and center. Plug in your email address and you’ll get regular updates regarding how to improve your effectiveness. As always, my articles, books, video and audio materials are available with the click of a button. You can also find an up-to-date schedule of workshops and intensive trainings in feedback informed treatment (FIT).

Speaking of FIT, have you visited the www.whatispcoms.com website? It’s the official website for ICCE’s Partners for Change Outcome Management System. Here you can learn everything you need to know to get started using the feedback process documented to improve effectiveness and approved by SAMHSA as an evidence-based practice. What’s new? Thanks to ICCE members around the world, the site is available in five different languages, including: English, Dutch, Swedish, Norwegian, and Danish. Until next time!

Are you any good as a therapist? The Legacy of Paul W. Clement

March 26, 2014 By scottdm 4 Comments

Twenty years ago, I came across an article published in the journal, Professional Psychology. It was written by a psychologist in private practice, Paul Clement. The piece caught my eye for a number of reasons. First, although we’d never met, Paul lived and worked in a town near my childhood home: Pasadena, California. Second, the question he opened his article with was provocative, to say the least, “Are you any good?” In other words, how effective are YOU as a psychotherapist? Third, and most important, he had compiled and was reporting a quantitative analysis of his results over the last 26 years as a practicing clinician. It was both riveting and stunning. No one I knew had ever done had published something similar before.

In graduate school, I’d learned to administer a variety of tests (achievement, vocational, personality, projective, IQ, etc.). Not once, however, did I attend a course or sit in a lecture about how to measure my results. I was forced to wonder, “How could that be?” Six years in graduate school and not a word about evaluating one’s outcomes. After all, if we don’t know how effective we are, how are any of us supposed to improve?

What was the reason for the absence of measurement, evaluation, and analysis? It certainly wasn’t because psychotherapy wasn’t effective. A massive amount of research existed documenting the effectiveness of treatment. Paul’s research confirmed these results. Of those he’d worked with, 75% were improved at termination. Moreover, such results were obtained in a relatively brief period of time, the median number of sessions used being 12.

Other results he reported were not so easy to accept. In short, Paul’s analysis showed that his outcomes had not improved over the course of his career. At the conclusion of the piece, he observed, “I had expected to find that I had gotten better and better over the years, but my data failed to suggest any systematic change in my therapeutic effectiveness across the 26 years in question…it was a bad surprise for me.” (p. 175).

For years, I carried the article with me in my briefcase, hoping that one day, I might better understand his findings. Maybe, I thought, Clement was simply an outlier? Surely, we get better with experience. It was hard for me to believe I hadn’t improved since my first, ham-handed sessions with clients. Then again, I didn’t really know. I wasn’t measuring my results in any meaningful way.

The rest is history. Within a few short years, I was routinely monitoring the outcome and alliance at every session I did with clients. Thanks to my undergraduate professor, Michael Lambert, Ph.D., I began using the OQ 45 to assess outcomes. Another mentor, Dr. Lynn Johnson had developed a 10-item scale for evaluating the quality of the therapeutic relationship, know as the Session Rating Scale. Both tools became an integral part of the way I worked. Eventually, a suggestion by Haim Omer, Ph.D., led me to consider creating shorter, less time consuming visual analogue versions of both measures. In time, together with colleagues, the ORS and SRS were developed and tested. Throughout this process, Paul Clement, and his original study remained an important, motivating force.

Just over a year ago, Paul sent me an article evaluating 40 years of his work as a psychotherapist. Once again, I was inspired by his bold, brave, and utterly transparent example. Not only had his outcomes not improved, he reported, they’d actually deteriorated! Leave it to him to point the way! As readers of this blog know, our group is busy at work researching what it takes to forestall such deterioration and improve effectiveness. Last year, we summarized our findings in the 50th Anniversary issue of Psychotherapy. As I write, we are preparing a more detailed report for publication in the same journal.

Yesterday, I was drafting an email, responding to one I’d recently received from him, when I learned Paul had died. I will miss him. In this, I know I’m not alone.

The Importance of "Whoops" in Improving Treatment Outcome

December 2, 2012 By scottdm Leave a Comment

“Ring the bells that still can ring,
Forget your perfect offering
There is a crack in everything,
That’s how the light gets in.”

Leonard Cohen, Anthem

Making mistakes. We all do it, in both our personal and professional lives. “To err is human…,” the old saying goes. And most of us say, if asked, that we agree whole heartedly with the adage–especially when it refers to someone else! When the principle becomes personal, however, its is much more difficult to be so broad-minded.

Think about it for a minute: can you name five things you are wrong about? Three? How about the last mistake you made in your clinical work? What was it? Did you share it with the person you were working with? With your colleagues?

Research shows there are surprising benefits to being wrong, especially when the maker views such errors differently. As author Alina Tugend points out in her fabulous book, Better by Mistake, custom wrongly defines a mistake as ” the failure of a planned sequence of mental or physical activities to achieve its intended outcome.” When you forget a client’s name during a session or push a door instead of pull, that counts as slip or lapse. A mistake, by contrast, is when “the plan itself is inadequate to achieve it’s objectives” (p. 11). Knowing the difference, she continues, “can be very helpful in avoiding mistakes in the future” because it leads exploration away from assigning blame to the exploring systems, processes, and conditions that either cause mistakes or thwart their detection.

Last week, I was working with a talented and energetic group of helping professionals in New Bedford, Massachusetts. The topic was, “Achieving Excellence: Pushing One’s Clinical Performance to the Next Level of Effectiveness.” As part of my presentation, I talked about becoming more, “error-centric” in our work; specifically, using ongoing measurement of the alliance to identify opportunities for improving our connection with consumers of behavioral health services. As an example of the benefits of making mistakes the focus of professional development efforts, I showed a brief video of Rachel Hsu and Roger Chen, two talented musicians who performed at the last Achieving Clinical Excellence (ACE) conference. Rachel plays a piece by Liszt, Roger one by Mozart. Both compositions are extremely challenging to play. You tell me how they did (by the way, Rachel is 8 years old, Roger. 9):

Following her performance, I asked Rachel if she’d made any mistakes during her performance. She laughed, and then said, “Yes, a lot!” When I asked her what she did about that, she replied, “Well, its impossible to learn from my mistakes while I’m playing. So I note them and then later practice those small bits, over and over, slow at first, then speeding up, until I get them right.”

After showing the video in New Bedford, a member of the audience raised his hand, “I get it but that whole idea makes me a bit nervous.” I knew exactly what he was thinking. Highlighting one’s mistakes in public is risky business. Studies documenting that the most effective clinicians experience more self-doubt and are more willing to admit making mistakes is simply not convincing when one’s professional self-esteem or job may be on the line. Neither is research showing that health care professionals who admit making mistakes and apologize to consumers are significantly less likely to be sued. Becoming error centric, requires a change in culture, one that not only invites discloure but connects it with the kind of support and structure that leads to superior results.

Creating a “whoops-friendly” culture will be a focus of the next Achieving Clinical Excellence conference, scheduled for May 16-18th, 2013 in Amsterdam, Holland. Researchers and clinicians from around the world will gather to share their data and experience at this unique event. I promise you don’t want to miss it. Here’s a short clip of highlights from the last one:

My colleague, Susanne Bargmann and I will also be teaching the latest research and evidence based methods for transforming mistakes into improved clinical performance at the upcoming FIT Advanced Intensive training in Chicago, Illinois. I look forward to meeting you at one of these upcoming events. In the meantime, here’s a fun, brief but informative video from the TED talks series on mistakes:

By the way, the house pictured above is real. My family and I visited it while vacationing in Niagara Falls, Canada in October. It’s a tourist attraction actually. Mistakes, it seems, can be profitable.